Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury.
Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury.
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对患有复杂的轻度至重度创伤性脑损伤的青少年进行辅导员协助解决问题的随机临床试验后的长期行为结果。
DOI：
10.1089/neu.2014.3684
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发表时间：
2015
影响因子：
4.2
通讯作者：
Stancin,Terry
中科院分区：
文献类型：
--
作者：
Wade,ShariL;Taylor,HGerry;Cassedy,Amy;Zhang,Nanhua;Kirkwood,MichaelW;Brown,TanyaM;Stancin,Terry
家庭问题解决疗法（FPST）已被证明可以减少儿童创伤性脑损伤（TBI）后的行为问题。目前尚不清楚治疗效果是否得到维持。我们试图评估TBI后最初一年内向青少年提供的基于网络的顾问辅助FPST（CAPS）干预与互联网资源比较（IRC）干预相比，行为问题的改善。我们假设家庭社会经济地位、儿童教育状况和基线症状水平会随着时间的推移而调节治疗的疗效。参与者包括132名12-17岁的青少年，他们在研究入组前1-6个月患有复杂的轻度至重度TBI。主要结果是儿童行为检查表内化和外化总数。采用随机截距和斜率进行混合模型分析，以检查随时间推移的组间差异。对于内化问题，存在显著的组×时间×年级相互作用（F（1，304）=4.42;p=0.03），CAPS中的高中年龄参与者在基线后18个月报告的症状显著低于IRC中的参与者。阐明内化问题影响性质的事后分析显示，焦虑/抑郁（p=0.03）和躯体主诉子量表（p=0.04）存在显著的组×时间×年级相互作用。结果还表明，随着时间的推移，在基线时报告外化行为问题升高的CAPS参与者有显著改善（F（1，310）=7.17;p=0.008）。研究结果表明，CAPS可能会导致长期改善行为问题的年龄较大的青少年和那些与治疗前的症状。
Family problem-solving therapy (FPST) has been shown to reduce behavior problems after pediatric traumatic brain injury (TBI). It is unclear whether treatment gains are maintained. We sought to evaluate the maintenance of improvements in behavior problems after a Web-based counselor-assisted FPST (CAPS) intervention compared to an Internet resource comparison (IRC) intervention provided to adolescents within the initial year post-TBI. We hypothesized that family socioeconomic status, child educational status, and baseline levels of symptoms would moderate the efficacy of the treatment over time. Participants included 132 adolescents ages 12–17 years who sustained a complicated mild-to-severe TBI 1–6 months before study enrollment. Primary outcomes were the Child Behavior Checklist Internalizing and Externalizing Totals. Mixed-models analyses, using random intercepts and slopes, were conducted to examine group differences over time. There was a significant group×time×grade interaction (F(1,304)=4.42;p=0.03) for internalizing problems, with high school–age participants in CAPS reporting significantly lower symptoms at 18 months postbaseline than those in the IRC. Post-hoc analyses to elucidate the nature of effects on internalizing problems revealed significant group×time×grade interactions for the anxious/depressed (p=0.03) and somatic complaints subscales (p=0.04). Results also indicated significant improvement over time for CAPS participants who reported elevated externalizing behavior problems at baseline (F(1, 310)=7.17;p=0.008). Findings suggest that CAPS may lead to long-term improvements in behavior problems among older adolescents and those with pretreatment symptoms.